28 Chapter 2 Approaches to learning is a related concept and identifies the motives (i.e., goals) and strategies of students for learning. Traditionally, a deep and surface approach were distinguished (18,19). A deep learning approach indicates a student’s motive for meaningful understanding and the use of associated learning strategies like relating new knowledge to prior knowledge. A surface learning approach indicates a motive of meeting minimal requirements and relying on rote memorization strategies. Nowadays, an additional strategic learning approach is distinguished, indicated by a student’s motive of high achievement, and use of both deep and surface learning strategies. Relating approaches to learning to active learning: surface learners favor subject-matter experts to tell them what they should know. Deep learners favor activities that allow them to use higher order thinking skills. Both epistemic beliefs and approaches to learning affect how students perceive and value active learning methods, which in turn affects how willingly students engage in active learning methods (20). In this study, we aimed to identify the diversity in medical students’ appreciation of small-group active learning, based on their epistemic beliefs and approaches to learning. Ultimately, this knowledge may help teachers to improve engagement in active learning in their classes by tailoring to different needs and wishes. Teachers can make better-informed decisions about specific learning activities, and communicate their value in relation to students’ epistemic beliefs and approaches to learning. METHOD Setting We conducted this study at the Faculty of Medicine of the Vrije Universiteit Amsterdam (FMVU) in the Netherlands. Medical education in the Netherlands is competency-based (derived from the CanMEDS framework) and consists of three years of preclinical education (Bachelor’s degree program) followed by three years of clinical education (Master’s degree program) (21). The FMVU has approximately 2300 students studying in the Bachelor and Master programs. This study took place in the Bachelor phase of medical training. At the start of their first year, students enroll in study groups of twelve students. These groups are formed for a semester and meet twice per week for two hours to discuss written patient cases and work on accompanying assignments (designed to help students relate clinical signs and symptoms to underlying mechanisms). There are fifty-four meetings spread out over the academic year. Students themselves are responsible for preparing and leading the meetings, taking notes, asking and answering questions, giving presentations, and providing each other with feedback. Students collaborate between meetings to work on the cases and prepare the presentations. Teachers (called tutors) take on the role of facilitators during study group meetings; they focus on the process of the meeting and observe individual contributions to the learning process of the group. They also assess the professional behavior of students
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